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DTC Ads Take “Consumer-Driven Medicine” to ‘Absurd’ Heights

Medical device makers are taking direct-to-consumer (DTC) advertising to a perilous new level. In a piece titled “Crossing the Line in Consumer Education?” that will appear in the May 22 issue of The New England Journal of Medicine (NEJM), Drs. William E. Boden, and George A. Diamond tackle the issue, arguing that a new campaign to peddle medical devices directly to patients warrants close scrutiny. Manufacturers are inviting consumers to decide not only what is best for them, but what is best for their surgeons. This is “consumer-driven medicine” at its most dangerous.

Boden and Diamond focus on a 60-second television spot for Johnson & Johnson’s drug-eluting coronary stent, “the Cypher,” which debuted during last year’s Thanksgiving match-up between the Dallas Cowboys and the New York Jets. (Click here to view the advertisement in question).

The commercial has all of the hallmarks of the drug industry’s highly polished DTC advertising: First, we’re introduced to “the tough guy” – a once-powerful man who now is “cornered by chest pains” and sits slumped in his arm chair. Then, we are shown how he can reclaim his life in a montage of joyous physical activity accompanied by upbeat music. Of course, “this product isn’t for everyone,” we’re told. But “life is wide open. It all depends on what you’ve got inside.”

In the campaign to put the health care “consumer” in the driver’s seat, where he can have “control” and “choice,” J&J is breaking new ground. This ad isn’t for a pill that you buy in a pharmacy but rather for a coronary stent, a wire mesh device that is placed in an artery which has been blocked by fatty deposits. Doctors first thread a tiny balloon into the artery and inflate it to clear the blockage; then they insert a stent into the artery, and a second balloon expands the stent to keep the newly cleared blood vessel wide open.

“Unlike a drug,” Boden and Diamond point out, “whose use merely
requires an office visit to a physician and a prescription the patient
can fill at a pharmacy, a specialized medical device such as a stent
can be selected and implanted only by someone with a very sophisticated
medical understanding that no member of the lay public could
realistically expect to gain from a DTCA campaign.”

This is an important point. It’s bad enough that some patients are now
sold drugs via a sound-bite, but it is even more pernicious to pretend
that the pros and cons of a medical device can be condensed into a
30-second spot. In this case you’re not just popping a pill that you
can decide to stop taking if you don’t like the way it makes you feel.
Medical devices are literally installed in our bodies. Even if
short-term results look promising, the reality of medical devices is
that they stay in our bodies; and so complications often do not become
evident until well after their installation.

Moreover, it’s imperative that a surgeon is comfortable with the device
he is using. In Money-Driven Medicine George Cipoletti, co-founder of
Apex Surgical, a company that focuses on joint replacement products,
explains that, when it comes to devices, “90 percent of success is
determined not by the device itself but, by how good the surgeon is at
implanting that particular device—how much experience he has with it.”

John Cherf, a Chicago knee surgeon, adds that surgical technique
accounts for “80 to 85 percent” of a successful operation. “Think of it
this way,” said Cherf. “If you gave Tiger Woods 20-year old golf clubs,
and gave me the newest clubs, he’d still kick my butt.”

This is another reason why Boden and Diamond find it “almost
unimaginable that a patient would challenge an interventional
cardiologist’s judgment about the use of a particular stent or that a
cardiologist would accede to a patient’s request for a particular stent
on the basis of the information gleaned from a television ad. Indeed,
the notion that television viewers, inspired by such an ad, would go to
their physicians and request not only a stent but a specific brand and
model of stent is frightening, if not utterly absurd.”

Yet why else would J&J spend millions on television advertising?
The company’s goal is to create demand—a “buzz” that will cause
patients to ask about the product, and that will make some hospitals
and surgeons feel that they must use it.

This is what happened with another J&J product, a spinal device
called “Charité.” After being approved by the FDA in 2004, Charité was
heavily promoted. By the fall of 2005, more than 3,000 of the spinal
discs had been implanted—even though only two of the nation’s eight
largest insurers had agreed to pay for the operation. Some surgeons
were questioning the safety of the device, but patients who read
favorable reports about Charité online or in the press were beginning
to demand the operation.

As a result, some hospitals were willing to absorb the cost of the
operation even though insurers wouldn’t reimburse. Dr. John Brockvar,
chief of neurosurgery at Wyckoff Heights Hospital in Brooklyn, told Dow
Jones Newswires that his hospital gave him permission to implant the
device “because it was important to be on the leading edge.”

“Some doctors say they’re worried they will lose business if they don’t offer the Charité option to patients,” The Wall Street Journal reported. “There’s a feeling that it isn’t adequately proven, but there’s anxiety about being left behind.” [my emphasis]

In an almost pure example of money-driven, consumer-driven medicine,
manufacturers intent on profits pushed consumers to push doctors and
hospitals to use a product that they were not convinced was safe. This
is not how we want medical decisions to be made.

Today, Charité remains controversial. There are many questions about long-term complications, and last spring, Medicare announced that it would no longer cover Charité for patients over sixty.

J&J’s stent, Cypher, also has its critics—which may be one reason
why the company is pumping up promotion via television advertising. In
the past, drug-makers have poured money into television ads for the
same reason that movie studios resort to expensive television
advertising: the critics are panning the product. If a drug-maker is
having a hard time selling its new product directly to
physicians—either because the reviews in the medical journal reviews
are mixed, or because it is a “me-too “product that appears to offer
little benefit over older, less expensive drugs—manufacturers go
directly to the consumer, who is less likely to be aware of what the
critics are saying.

This may be what J&J is doing with Cypher, one of the new
“drug-eluting stents” that, unlike older, less expensive “bare-metal
stents” release drugs which are supposed to prevent arteries from
re-clogging.

If you were to judge drug-eluting stents solely by the Cypher
advertisement, you might think they’re a remarkable sure-fire
innovation. After all, as the commercial asserts, “when your arteries
narrow, so does your life.” Who wouldn’t want to lead a better life
thanks to a device that—again, according to the advertisement—is
“studied,” “trusted” and “proven”?

Unfortunately, while drug-eluting stents have been studied, they are
far from “proven.” In fact, there is much debate over whether or not
they’re good options for folks with clogged arteries. In a 2007 NEJMarticle,
William Maisel of Harvard Medical School asserted that, since the FDA
approval of drug-eluting stents in 2003, “concerns about an increased
risk of late stent thrombosis [i.e. late onset blood clots] have arisen
and have been exacerbated by insufficient and conflicting information
in the public domain.”

This is putting it diplomatically. According to Maisel, a major 2006
study found “that between 7 and 18 months after implantation, the rates
of nonfatal myocardial infarction [i.e. heart attacks], death from
cardiac causes, and…stent thrombosis were higher with drug-eluting
stents than with bare-metal stents [i.e. those that don’t release
drugs].”

Equally disconcerting is a 2003 Swedish study cited by NEJM in
which doctors examined a computer registry of every Swedish stent
patient for the years 2003 and 2004. This analysis of almost 20,000
people found that when drug-eluting stents were implanted, patients
were slightly more likely to die than those who had old-fashioned
bare-metal stents. Four years later a Columbia University study
reported that the four-year rate of stent thrombosis was 1.2 percent
amongst patients who had received the Cypher, as opposed to 0.6 percent
for those who had received bare-metal stents—double the proportion.

On the other hand, a more recent but smaller study of 6,552 cases published in the NEJM
comparing bare metal to drug-eluting stents for so-called “off-label”
use (use not specifically approved by the FDA), found a lower rate of
complications and no increased risk of death or heart attack for the
drug-coated stents. But in the same issue of the NEJM, a study
suggested that if patients have more than one blocked artery, bypass
surgery provides a lower risk of death and heart attacks than do
procedures involving any type of stent.

Questions about when to use stents, and what kind of stent to use, are
far from resolved. As Boden and Diamond point out, this underlines the
absurdity of J&J’s effort to sell Cypher “to millions of people
who are ill-equipped to make judgments about the many clinically
relevant but subtle and complex therapeutic issues that even
specialists continue to debate.”

But just how likely is it that surgeons really will respond to consumer demands?

Much to their chagrin, doctors are finding that pressure from patients
does in fact change their behavior. In one of the most compelling analyses
of this dynamic to date, a team led by the University of California had
trained actors make 298 visits to 152 primary-care physicians,
portraying patients with major depression or adjustment disorder. The
actors presented doctors with three types of scenarios: requests for
specific brands of medications, general requests for medications
without naming brands, and no requests for medication.

For major depression, physicians prescribed antidepressants at a rate
of 53 percent for brand-specific requests; 76 percent for general
requests; and 31 percent for no requests. For adjustment disorder,
physicians prescribed antidepressants at a rate of 55 percent for
brand-specific requests; 39 percent for general requests; and 10
percent for no requests. In other words, people with identical
conditions were prescribed drugs at dramatically different rates
depending on what they asked for.

The Wall Street Journals’ report that hospitals and doctors feel
that they must experiment with J&J’s spinal disc, Charité, suggests
that this logic can carry over to medical devices. One can envision a
spike in procedures and surgeries thanks to patient demand. But do we
really want a system where knee-jerk patient response to 30-second
commercials trumps medical expertise?

Patients want to be able to ask questions. They want their doctors to
take the time to give them detailed answers. But the more DTC ads
encourage patients to make demands of their doctors, the more doctors
and patients are positioned as antagonists rather than collaborators.

That’s a recipe for friction, not patient satisfaction. One last
question: even if patients get the Cypher they want, what happens when
they develop a blood clot? Who is responsible then?

These ads and the drug ads are both “Orwellian and Felliniesque” in one fell swoop.
These ads embody much is what is wrong not ony with American medicine but with American culture.
Thanks Maggie
Dr. Rick Lippin
Southampton,Pahttp://medicalcrises.blogspot.com

The first time I saw the ad for the Cypher stent, I thought it was ludicrous too. As it happens, I have one. Here’s the sequence of events which I think is probably fairly typical. I visit my cardiologist complaining of chest discomfort that is worse and different from my recent history. He administers a standard stress test and listens to my heart as well. The verdict: there has been an adverse change since my last test. He refers me to an interventional cardiologist for an angiogram. During the test, he finds a significant blockage in one artery and informs me that he is going to insert a stent right then and there. Out of curiosity, I ask him does he use the J&J stent or the Boston Scientific product? Answer: J&J. The only reason I ask is that I own some stock in J&J, but I just assume he is using what he thinks is best and is most comfortable with. It wouldn’t have mattered if I preferred Boston Scientific.
By contrast, the procedure to get the spinal product put in is scheduled well in advance and is more elective, at least as to timing. There is much more opportunity to discuss pros and cons of various alternatives. As for drugs, doctors may see little harm in going along with what the patient wants – a brand vs. the generic since the doctor gets his fee either way. If insurance has to pay more for the brand name drug, it’s not his or her concern.
I can’t imagine that any patient in his right mind would come out and ask for a stent, let alone a specific brand. While I have very high respect for J&J generally, this ad campaign is just plain dumb.

it may be a tad off-topic, but seems relevant to observe that such direct-to-consumer medical ads are basically carrying the network nightly news shows at the moment and have been for some time. take away the ads and the shows might disappear as well.
if a smooth doctor-patient relationship is collaborative, what’s the harm for the patient to ask about a product he’s been alerted to by a TV ad and allow the physician to shoot the idea down. I think we all accept that the doctor knows more and hope the doctor won’t do something inappropriate. if that’s true, what’s wrong if the patient knows a dab more about the possibilities, albeit in a way as biased as advertising always is.

In a society with an endless “War on drugs”, it seems a bit schizo to advertise that every human frailty has its drug answer! No wonder Rx drugs are now the latest youth abuse trend. Do we really believe or want to believe that all healthcare is drug/device related?

Dearest RedScrubs Scrubby Winner,
Going over our records has brought to my attention that not all winners of the Scrubby Award have gotten their free set of red scrubs. We hate to see this happen. After all, they are free. Once again, this is not a gimmick to get you to buy a single thing. We’re just giving them away to the weekly blog winners. So, if you haven’t gotten your free set of red scrubs, then please shoot me a line so that we can correct a dastardly wrong!
Sincerely yours,
Dr. Incognito
Redscrubs.com

I liked the comment about choosing Tiger Woods with poor golf clubs, but how are we supposed to know which surgeons are the “Tiger’s” of their profession? If the information on which doctor has the best risk adjusted outcomes is not available, we go with the latest technology.

Your Television as you doctor?
Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network.
This is called direct to consumer advertising, and doctors would prefer they did not exist.
Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.
The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.
DTC advertising is also a catalyst for and similar to disease mongering.
Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.
“Men of ill judgment oft ignore the good that lies within their hands till they have lost it” —
Sophocles
Dan Abshear

Dan, Michael, Dr. Incognito, —
Thanks for your comments.
Dan– Yes, I agree with everything you say. You make a particualrly good point here: “Also, DTC ads discuss only one treatment option normally when likely several treatment options exist for authentic medical disorders. ”
Too often patients don’t realize that they have less expensive options, or options that carry fewer risks. If they come in and demand what they saw on tv, a overworked doctor may just give it to them (as long as he doens’t have reason to think it will hurt them) without
explaining the options.
Michael–What the source who talks about Tiger Woods is saying is that you don’t want the newest medical technology, you want the technology your doctor is most comfortable with.
What you want to ask the doctor is : how many times have you done this procedure? And “how many times have you done it with this particular implant?”
A doctor who is “good” if not “outstanding” will have more success with an implant that he has used hundreds of times than an “outstanding” doctor doing a procedure with a new implant for the third time. Typically the implant salesman with be with him in the OR, at his elbow, showing him how to use it. This is when tragedies occur.
To research technologies and demand a doctor use the one you picked is foolish. You don’t want to be a test patient.
These devices are, to a large degree, commodities, not that different from each other, though the newer ones have more bells and whistles.
In the end, all we can say about new devices is that we know less about them and the risks 8 years down the road.
AS for transparent information about outcomes–people are working on this, but it’s very difficult.
We need outcomes reserach that tells us more than whether the patient lived or died. We need to know how he functioned after the operation.
This is very subjective information. Some slightly depressed people will sigh, and say “well, I guess I’m okay, though I doubt I’ll ever feel 100 percent.”
A more cheerful person whose outcome was essentially the same will say “I feel better than I have in years. I’m enjoying life.”
Outcomes reserach also needs to include what happens down the line. You could look at the record of a doctor who did angioplasties using stents and see that a very high percentage of patients survived and see, by their subjective reprots, to be doing better.
Ten years later, if you went back to the same doctors’ files you might find that a signficant percetage suffered complicatoins– the stent slipped away from where it was suppposed to be, they suffered a blood clot; they had to have another operatoin to replace the stent; they had to have a by-pass (and probably should have had a by-pass in the first place.)
And that’s if he continued to see the patients he originally treated. Often, the patient will have moved, changed insurance, or changed doctors. There’s no follow-up information. So how do you judge the outcome then?
Finally, in terms of outcomes, the COO of one of New York’s major hospitals once said to me:
“It’s all well and good to ask, did the patient survive, and how is he functioning? But the most important question is the one no one asks: “Did the patient need the operation in the first place?”
It’s much harder to judge the success rate of a doctor who is over-treating fairly healthy patients who didn’t need a by-pass–they just needed a change of diet and exercise.
The fact that only 2 % died, and only 14% suffered complications that required re-admission to the hospital does not make him a doctor that you want . . .
This is why it is very difficult to provide “transparent” outcomes information.
Dear Dr. Incognito:
Thank you for the award.
I told Niko to send in for his Red Scrubs!!! He’ll be back to you next week.
Everyone else on this thread–I’ll be back to you later. . .

Dan, Michael, Dr. Incognito, —
Thanks for your comments.
Dan– Yes, I agree with everything you say. You make a particualrly good point here: “Also, DTC ads discuss only one treatment option normally when likely several treatment options exist for authentic medical disorders. ”
Too often patients don’t realize that they have less expensive options, or options that carry fewer risks. If they come in and demand what they saw on tv, a overworked doctor may just give it to them (as long as he doens’t have reason to think it will hurt them) without
explaining the options.
Michael–What the source who talks about Tiger Woods is saying is that you don’t want the newest medical technology, you want the technology your doctor is most comfortable with.
What you want to ask the doctor is : how many times have you done this procedure? And “how many times have you done it with this particular implant?”
A doctor who is “good” if not “outstanding” will have more success with an implant that he has used hundreds of times than an “outstanding” doctor doing a procedure with a new implant for the third time. Typically the implant salesman with be with him in the OR, at his elbow, showing him how to use it. This is when tragedies occur.
To research technologies and demand a doctor use the one you picked is foolish. You don’t want to be a test patient.
These devices are, to a large degree, commodities, not that different from each other, though the newer ones have more bells and whistles.
In the end, all we can say about new devices is that we know less about them and the risks 8 years down the road.
AS for transparent information about outcomes–people are working on this, but it’s very difficult.
We need outcomes reserach that tells us more than whether the patient lived or died. We need to know how he functioned after the operation.
This is very subjective information. Some slightly depressed people will sigh, and say “well, I guess I’m okay, though I doubt I’ll ever feel 100 percent.”
A more cheerful person whose outcome was essentially the same will say “I feel better than I have in years. I’m enjoying life.”
Outcomes reserach also needs to include what happens down the line. You could look at the record of a doctor who did angioplasties using stents and see that a very high percentage of patients survived and see, by their subjective reprots, to be doing better.
Ten years later, if you went back to the same doctors’ files you might find that a signficant percetage suffered complicatoins– the stent slipped away from where it was suppposed to be, they suffered a blood clot; they had to have another operatoin to replace the stent; they had to have a by-pass (and probably should have had a by-pass in the first place.)
And that’s if he continued to see the patients he originally treated. Often, the patient will have moved, changed insurance, or changed doctors. There’s no follow-up information. So how do you judge the outcome then?
Finally, in terms of outcomes, the COO of one of New York’s major hospitals once said to me:
“It’s all well and good to ask, did the patient survive, and how is he functioning? But the most important question is the one no one asks: “Did the patient need the operation in the first place?”
It’s much harder to judge the success rate of a doctor who is over-treating fairly healthy patients who didn’t need a by-pass–they just needed a change of diet and exercise.
The fact that only 2 % died, and only 14% suffered complications that required re-admission to the hospital does not make him a doctor that you want . . .
This is why it is very difficult to provide “transparent” outcomes information.
Dear Dr. Incognito:
Thank you for the award.
I told Niko to send in for his Red Scrubs!!! He’ll be back to you next week.
Everyone else on this thread–I’ll be back to you later. . .

Rick, Allan, Barry,Jim,
Dr. Rick–well-put.
Allan–
Yes, I was told that Scandanavian countires would have no need for Garadasil (Merck’s “vaccine” against
cervical cancer) because
Pap smears are free, everyone gets them,and these countries have actually wiped out cervical cancer/ The person who told me this was the U.S. doctor who was the lead researcher on Garadsil.
On cancer survival rates, five-year outcomes are very mis-leading. For example, in the U.S. PSA testing for prostate cancer has become routine for men 60 and older (though the National Cancer Society now tells us it does no good in “altering the course of the disease” and the American Cancer Society do no longer recommends it.
Nevertheless, many men still get the PSA test and so more men in the U.S. who have early-stage prostate cancer found out earlier than they are in other countires where PSA testing is not as common..
But the men in the U.S. are just as likely to die of the cancer.
The only difference is that they know earlier that they have it. So, they are more likely to survive five years before it kills them. What is the advantage of walking around for five years knowing that you have it?
At this point, the only is that benefit is that you MIGHT POSSIBLY get a treatment that Might Possibly save you. But we have no evidence that any of our current treatments for early stage prostate cancer save lives or even add so much as a month to the patient’s life. (That’s what NCS means when it says there is no evidence that early detection and treatment alters the course of the diease.)
The downside of early detection and treatment for men in the U.S. is, by contrast, certain. Once they know their PSA level is high, they must struggle to decide whether or not to get treatment. In most cases, the slow-growing cancer will never bother them. And there’s no proof of benefit from treatments. STill, some feel they must do something . . .
So they undergo surgery or radiation, and, in many cases, suffer the life-changing side effects of those treatments– incontinence and/or impotence.
Similarly, 5-year survival rates may be better for breast cancer because American women go for mammograms and MRIs more often–even though we have been told that we don’t need to go for a mammogram every year once we’re 40, many women do.
So small tumors are found, sometimes cancer in situ– and women have treatments that they don’t need. Sure, more of them “survive” 5 years after diagnosis, but the same number would have survived with less aggressive treatment (lumpectomy not mastectomy), and in some cancers, with no treatment.
When you over-treat your 5-year survival numbers look good because you were treating people who weren’t sick.
Barry- Yes, the J&J ad is just plain dumb. But I’m afraid that J&J realizes that many patients, doctors and hospitals also are just plain dumb.
It made no sense for doctors and hopsitals to start using the Charite disc just because it was getting a lot of publicity and patients were asking about it. But they did. And it has done great harm
to many patients.
On drug ads: they are pernicious because, by law, tv drug ads do not have to list all important risks ( because there just isn’t time). And doctors report that patients do pressure them to prescribe drugs that the doctors know are not fully tested–adn the doctors give in because they are exasperated, just don’t have time to argue with the patient etc.
Finally, you write: “As for drugs, doctors may see little harm in going along with what the patient wants – a brand vs. the generic since the doctor gets his fee either way. If insurance has to pay more for the brand name drug, it’s not his or her concern.”
I think most doctors who read this blog would disagree. They’re not just there to get there fee. They want what is best for our health. And they realzie that if we keep over-paying for brand-name drugs we won’t be able to afford other healthcare that we need. This is one reason why Medicare is running out of money–Medicare is paying private insurers far too much to administer drug programs,a nd private insurers, in turn, are paying top prices for those drugs without negotiating for discounts the way other countires do.
Responsible doctors are keenly aware of the healthcare crisis in this country, and the fact that if we overspend health care dollars in one area, we won’t have enough to spend in another area.
Jim– Yes, those drug ads are helping to carry the network nightly news. And that’s also why, too often, the news carries a “story” about a medical breakthrough that really isn’t a breakthrough. Though NBC, at least, has been getting better about warning about recalls, drugs that are hurting us, etc.
But I have to disagree when you write: ” I think we all accept that the doctor knows more and hope the doctor won’t do something inappropriate. if that’s true, what’s wrong if the patient knows a dab more about the possibilities, albeit in a way as biased as advertising always is.”
First, unfortunately, a
great many people don’t accept that doctors know more than we do about medicine. The whole consumer-driven movement has persuaded too many people that they know as much as the doctor. And doctors who don’t have time to argue with them report that, too often, they just say “Fine, here’s the prescription you want.”
Also knowing “a dab about the possibilities” can be harmful, as in the old saying “A little knowledge is a dangerous thing.”
TV ads are not required to list all important risks. And, as a reader points out, they also don’t let the patient know that there are alternatives. Typically, the ad makes you feel that this is the best, only option for treating what ails you . . .
NG: I agree completely.
We should tell patients: “Just Say No to Drugs” (or at least ask more questions about whether your doctor thinks it’s completely necessary that you take another drug, just wants you to consider it, strongly recommends it, whatever. You might explain that you’re already taking 5 separate medications and are concerned about adding another one . .
As to the War on Drugs–it’s doing as much or more harm as the illegal drugs themselves. See the fabulous television series, “The Wire” on HBO (or rent it on Netflix.)
BTW I’ve been thinking about writing about the War on Drugs, the need for more drug clinics, how much we spend incarcerating kids, what might happen if we spent that money on good drug treatment programs, etc.
If anyone has good information on this–or can direct me to good websites and organizations, I’d appreciate it.

I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new when something old or generic would do the job for cheaper.